Benzodiazepine use and mortality of incident dialysis patients in the United States

Winkelmayer, WC; Mehta, Jyotsna; Wang, P.S.

doi:10.1038/sj.ki.5002548

Cited by 66 publications

(76 citation statements)

References 31 publications

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“…However, periodic limb movements improve only slightly in dialysis patients by treatment with pergolide, a dopamine agonist (20). Furthermore, a recent study has reported that benzodiazepine or zolpidem use is common in incident dialysis patients and may be associated with greater mortality (21). Optimal uremia control, in the form of nocturnal hemodialysis, may have a promising therapeutic effect (22,23).…”

Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Jung¹,

Lee

Baek³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Sleep disorders, including sleep-disordered breathing and periodic limb movements during sleep, are associated with an increased risk for cardiovascular diseases, which are the leading causes of death in patients with ESRD. This study investigated the association between sleep disorders and mortality in patients with ESRD.Design, setting, participants, & measurements: Thirty patients on maintenance hemodialysis, who were clinically stable for >2 months, underwent overnight polysomnography to evaluate sleep parameters.Results: All patients were followed for a median of 48 months (range: 14 to 62 months), and 14 of them died during the follow-up period. Among the sleep parameters, the percent of sleep time with arterial oxygen saturation <90% (T <90%), mean arterial oxygen saturation, and periodic limb movement index score were associated with significant increases in the risk of death. However, associations of the apnea-hypopnea index or oxygen desaturation index with mortality were NS. The hazard ratios (95% confidence intervals) for death per one SD increment in the log-transformed T <90% and periodic limb movement index score were 2.10 (1.06 to 4.15) and 2.48 (1.11 to 5.52), respectively, after adjusting for age.Conclusions: We found that nocturnal hypoxemia and periodic limb movement during sleep, rather than apnea itself, were associated with an increased risk for death in patients with ESRD. However, conclusions from this study should be drawn with caution, because they are limited by the small sample size.

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Section: Discussionmentioning

confidence: 99%

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Jung¹,

Lee

Baek³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Fifteen articles met inclusion criteria (1,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) (Figure 1). Agreement beyond chance between the two authors for article inclusion was good (kappa ϭ 0.79).…”

Section: Study Selectionmentioning

confidence: 99%

“…Only four studies were specifically designed to examine opioid and/or benzodiazepine use (7,(13)(14)(15). The data were collected prospectively in all studies, and one retrieved data from an administrative database (16). Patient baseline characteristics and eligibility criteria were reported in the majority of studies, but few described the proportions of patients with missing data.…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

“…Patient baseline characteristics and eligibility criteria were reported in the majority of studies, but few described the proportions of patients with missing data. Twelve studies reported on prevalent cross-sections of patients receiving hemodialysis (7,13-15,18 -25), whereas three restricted inclusion to patients starting hemo-or peritoneal dialysis in the last 3 months (1,16,17). One opioid study restricted prevalence estimates to the 50% of patients reporting ongoing pain (7).…”

Section: Quality Of Included Studiesmentioning

confidence: 99%

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Opioid and Benzodiazepine Use in End-Stage Renal Disease

Wyne

Rai

Cuerden

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events.Design, setting, participants, & measurements Two authors reviewed all relevant citations in MEDLINE/ EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in Ն50 dialysis patients were included. ResultsWe identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n ϭ 10) and 8 to 26% (95% CI, 7.1 to 27.3%; n ϭ 9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n ϭ 2). No study rigorously examined for adverse events. ConclusionsThe prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population.

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“…Few studies have assessed the prevalence of benzodiazepines use in elderly. In Brazil, the prevalence rates range from 6.1 to 21.7% and up to 32% in international studies 7,[15][16][17][18][19][20][21][22][23] . In this context, the aim of this study was to investigate whether the prevalence of use of BZD in the Midwestern region differs from other regions.…”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

Cunha

Souza

Cattanio

et al. 2015

J. bras. psiquiatr.

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Objective: The use of benzodiazepines (BZD) and associated factors in the elderly of Dourados, MS, Brazil was investigated. Methods: This is a cross-sectional population-based study using a multistage sampling design. Participants were 1,022 individuals aged ≥ 60 years. Measurements: socioeconomic status, schooling, demographic aspects, marital status, physical activity, hospitalizations, self-rated health, use of alcohol beverages and smoking were assessed by standard questionnaire. The drugs used were obtained by checking the prescription or package and classified according to the Anatomical Therapeutic Chemical Index. Chi-square test, Chi-square for linear tendency, Fisher's exact test and Poisson regression were used to assess association between variables. Results: The prevalence of use of BZD was 6.5% (CI95%: 5.1-8.2%). The oldest group (PR: 1.60 for 70-79 years and PR: 1.79 for ≥ 80 years), non-use of alcohol (PR: 4.14) and use of antidepressants (PR: 8.73) were the statistically associated characteristics. Conclusions: The prevalence of use of BZD in the study population was low, similar to findings of more recent Brazilian studies and lower than those obtained in international studies. The prevalence of use of BZD increased with aging and use of antidepressants. REsUMOObjetivo: Foi investigado o uso de benzodiazepínicos (BZD) e fatores associados em idosos no município de Dourados, MS. Métodos: Delineamento transversal, de base populacional com amostra de conglomerados estratificada e em múltiplos estágios. Os participantes totalizaram 1.022 indivíduos com idade > 60 anos. Foi utilizado questionário padronizado com as variáveis nível econômico, escolaridade, demográficas, situação conjugal, exercícios físicos, internações hospitalares, autopercepção de saúde, uso de bebida alcoólica e fumo. Os medicamentos utilizados foram obtidos por meio da verificação da receita médica ou embalagem e classificados segundo o Anatomical Therapeutic Chemical Index. Para avaliar a associação entre as variáveis foram utilizados os testes do qui-quadrado, de tendência linear, exato de Fisher e regressão de Poisson. Resultados: A prevalência do uso de BZD foi de 6,5% (IC95%: 5,1-8,2%). A maior idade (RP: 1,60 para 70-79 anos e RP: 1,79 para > 80

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Benzodiazepine use and mortality of incident dialysis patients in the United States

Cited by 66 publications

References 31 publications

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Nocturnal Hypoxemia and Periodic Limb Movement Predict Mortality in Patients on Maintenance Hemodialysis

Opioid and Benzodiazepine Use in End-Stage Renal Disease

Benzodiazepine use and associated factors in elderly in the city of Dourados, MS, Brazil

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